Suboptimal Care on Maternal Near-Miss Cases: A Study from s Tertiary Referral Hospital in East Java, Indonesia

Maternal near-miss cases shared the same characteristics as maternal mortality cases.Through analysis of those cases, it is expected that the factors which influence the maternal healthcare quality will be more detailed and enlighten the way to more focused effort to decreasematernal morbidity and mortality.To present the profile of substandard management that was found in maternal near-miss casesin a tertiary referral hospital in East Java, Indonesia, in January-August 2020.This research is descriptive retrospective research on maternal near-miss cases. The data wascollected from the medical records of the patients presented to the emergency room of a tertiaryhospital.There were 451 near-miss cases among the 1,526 cases of mothers who were referred to thehospital. Most of the near-miss cases with suboptimal services came from provincial capitals, and82 obstetricians sent the highest number of referrals. Based on the data collected, sub-optimal carefor near-death cases was carried out in antenatal care in as many as 87 cases, followed by delaysin referrals, and the least was suboptimal care in emergency management.Substandard maternal management was found in almost all classifications of maternal nearmisscases that were referred to a tertiary hospital in east Java, Indonesia, in 2020. Thatmanagement comprised of substandard antenatal care management, which is Unidentified historyof illness before pregnancy, Unidentified risk factors and pregnancy complications, Inadequatemanagement on the medical condition during pregnancy, deficient compliance patient due tovarious reasons, a financial problem which was not solved during antenatal care and lack ofknowledge of the patient of an emergency condition. The second substandard management wasmaternal emergency diagnosis and management, and the last was a late referral. Most healthproviders with substandard management come from the ob-gyn specialist and then first andsecondary health care facilities (private midwives, primary health care, clinics, and secondaryhospitals). This kind of substandard management should be noticed and addressed by all healthcare providers, professional organizations, policymakers, and others related to minimize the risk ofmaternal mortality and morbidity due to that substandard management.